
<form id="edit-form" class="form-horizontal form-ajax" role="form" data-toggle="validator" method="POST" action="">

    {:token()}

    <div class="form-group">
        <label for="c-total" class="control-label col-xs-12 col-sm-2">提现数量:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-total" readonly="ture" class="form-control" type="text" value="{$row.money}">
        </div>
    </div>
      <div class="form-group">
        <label for="c-content" class="control-label col-xs-12 col-sm-2">拒接理由:</label>
        <div class="col-xs-12 col-sm-8">
             <textarea class="form-control" data-rule="required" id="note" name="note">{$row['note']}</textarea>
        </div>

    <div class="form-group hidden layer-footer">
        <div class="col-xs-2"></div>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>